It’s Jan. 26, a Tuesday. But it could be any day, really, since schools closed a year ago.
After Porter’s online classes end around noon, he closes his computer and turns to the glow of his cellphone, where he kills the rest of the day watching videos on Netflix or YouTube. His bedroom lights are off, blinds closed against the afternoon sun.
“You wake up, go to pointless school, spend hours working for nothing, just to get an A, and then go to sleep, and repeat that,” said Porter, a Seattle high school student who often shows up late for class or zones out during virtual lessons. “I don’t even know what the days are. Everything is just blurry.”
Porter’s younger sister Grace, a middle schooler, was at first motivated to get ahead, recording classes and rewatching them to make sure she didn’t miss anything.
But around the winter holidays, her panic attacks began.
Grace and Porter didn’t struggle with mental health concerns before schools closed, but their new angst and sense of hopelessness reflect what many other students say they’re coping with during the pandemic. It’s a trend that cuts across generational lines but has hit young people particularly hard.
Among children, serious mental health issues are leading to emergency room visits, a sign that youth aren’t receiving help through usual channels, such as schools.
In Seattle, a typical night at Seattle Children’s hospital now includes admitting one to two children who have attempted suicide. Each week, the hospital’s emergency department sees about 170 children and adolescents for psychiatric emergencies — up from 50 a week before the pandemic. Nationally, emergency visits for mental health issues jumped by 31% among 12- to 17-year-olds during the pandemic.
Even before COVID-19, children and teens were reporting increasing incidence of hopelessness, anxiety and suicidal thoughts; these concerns disproportionately affect students of color, who are also less likely to report that they have an adult supporting them or that they are hopeful about the future. Isolation during a year away from school, on top of other stressors such as the national reckoning over racial justice, are compounding.
A few children with mental health conditions say they’ve gotten better during school closures, but anecdotally, many others are worsening, including those with disabilities. Youth like Grace and Porter, who were active in sports, the arts and with their friends pre-pandemic, are experiencing new and troubling symptoms, although they have not been diagnosed with a specific mental health condition. (The Seattle Times is using different names for the siblings to protect their privacy.)
Last month, Gov. Jay Inslee declared a youth mental health crisis and, in a move that acknowledges the critical role schools play in children’s mental health, mandated that school buildings reopen to all grades by April 19. In two weeks, Porter and Grace should be back in classrooms.
But simply returning to school buildings won’t reverse the cascading effects of a year in isolation, experts say. And many students will return to a system ill-equipped to support them. In Washington, schools employ 1,100-1,200 school psychologists, or one for every 1,000 students, according to the state’s association for school psychologists, far below national recommendations of one to 500-700 students.
“There’s not enough mental health providers [in schools nationwide] and this is, again, before COVID-19,” said Hesham Hamoda, staff psychiatrist at Boston Children’s Hospital. “Imagine how wide the gap is now, as really every child is impacted in some way.”
Washington schools don’t do a good job of handling everyday mental health issues, such as stress or anxiety, even in the best of times. And they’re part of a strained mental health system: In 2020, Washington came in at No. 43 on a national youth mental health ranking from Mental Health America.
“There are lots of other states that are doing a better job at this,” said Camille Goldy, director of student supports at the Washington Office of Superintendent for Public Instruction. For instance, she said, some states use Medicaid to pay for mental health services at schools — a way to fill gaps left by limited education funding. In Washington, the practice isn’t widespread.
Remote learning has made it even harder to identify students who need help. Many students, like Porter, became invisible to supportive adults when they kept their cameras off.
Mental health care access and quality are at least partly determined by ZIP code because of the way schools are funded here. The funding structure gives districts leeway to decide how many mental health professionals to hire, or whether to pay for other supports such as suicide-prevention programs or school-based health centers.
For example, Seattle Public Schools formed partnerships with the King County health department and local health providers to create school-based health centers that are staffed by mental health professionals and sit on school grounds. But some districts struggle to pay for a single school psychologist.
A handful of solutions are beginning to emerge.
Federal stimulus funding may prompt some schools to hire additional mental health staff, although the dollars are temporary. In his 2021-23 budget, Inslee proposed $400 million that districts could use, at least in part, to support student well-being; the overall biennial budget for schools is about $26 billion.
In Washington during the pandemic, school mental health training programs went virtual and reached more school staff — and expanded to parents and caregivers, a new study shows. Community-based organizations have shifted gears to target youth mental health needs and partner with school districts. And a group of researchers are focusing on equipping teachers to notice and intervene when students need help.
At a moment of extreme disruption, Hamoda said, the way mental health supports are delivered in schools “really needs disruptive innovations.”
For Porter, the textures of daily life have flattened, its colors dulled.
He has a close-knit group of friends, is on the football team and plays video games. Before the pandemic, he’d spend his afternoons at friends’ houses or at the gym. But with school still closed, he hasn’t seen friends nearly as often. “It’s made me feel really lonely,” he said. “There’s not many people I can rely on.”
Grace, his sister, says she’s noticed her brother’s mood sour as the months have worn on.
Her own emotions have oscillated between sadness, frustration and grief, she says. Around Christmas, with stress bubbling over and after her family made the decision to celebrate without extended family, Grace had a few panic attacks. Like her brother, she often finds herself scrolling for an escape on Netflix.
She takes long walks with her dad at night to “just let it out.” “I would just start crying, and I would just walk with him and talk about everything and why I’m feeling like that,” she said.
These feelings are a marked change for Grace, who used to spend her time playing basketball and soccer and attending choir practice.
Researchers and education officials are just beginning to collect data on how significantly the pandemic has affected the well-being of Washington children. University of Washington psychiatry and behavioral sciences professor Jason Kilmer is currently teaming up with the state’s health care authority and its education and health departments to ask more than 57,000 students questions such as “have you felt depressed or sad most days, even if you felt OK sometimes?”
The survey analysis is expected to be done before the end of the school year, said Kilmer, who is leading the work.
Young people face big barriers to getting mental health care. They don’t have agency over most parts of their lives, and can’t make decisions about buying health insurance, or whether to live in a community where care is accessible. Students may also face transportation challenges or discrimination.
In Washington, many school districts try to fill these gaps. At the most basic level, schools use so-called “social emotional learning” curricula, which gives all learners a broad set of tools to manage their emotions, cope with challenges and learn to be empathetic. The state also provides limited funding for school districts to hire school counselors, social workers and psychologists.
Many experts and educators agree that it makes sense for schools to provide support since children who are well are more likely to succeed academically. Children also spend so many hours of their days in class that it makes sense for schools to provide mental health care; research shows that if students receive mental health care, it’s most likely happening at school.
In fact, there’s so much research that experts have a good handle on what gold-standard school mental health programs should look like. Ideally, they say, schools would offer several “tiers” of support, ranging from schoolwide social emotional curricula or mentorship programs to more targeted interventions, such as cognitive behavior therapy. States would set up professional development programs and a statewide mental health monitoring system, to track trends or quickly identify districts where suicide rates are increasing.
But there’s a vast gap between best practice and reality.
“We have decades and decades of research showing the things that can be effective in schools,” said Aaron Lyon, co-director of the University of Washington’s SMART Center, which studies school-based mental health. “The extent to which that has been codified in legislation or paid for or funded is much more limited.”
Last legislative session, lawmakers introduced a bill that would have boosted funding and reduced the ratio of students to mental-health staff — but the proposal didn’t make it out of committee.
Another complicating factor: There’s a shortage of the most highly trained mental health staff — school psychologists — in Washington, said Alex Franks-Thomas, president of the Washington State Association of School Psychologists. This limits the staff’s work to evaluating students who need learning accommodations rather than serving students like Grace and Porter, who have more generalized concerns, like anxiety or depression.
“The general practice is, as long as you get all your special education stuff done, if you have extra time to work with general education students … then that’s great,” Franks-Thomas said. “We … can’t have a more expanded role because there aren’t enough of us.”
Students seek help for many reasons: relationship troubles and school stresses, as well as family responsibilities or tragedies. Trauma is also a serious concern, especially in places that have faced systematic oppression, such as low-income neighborhoods and communities of color.
The pandemic has exacerbated these concerns. And for students without access to school buildings, “there’s no relief from that,” said Sean Goode, executive director of King County-based nonprofit Choose 180.
“Young people don’t have any place to go to get away, to reset, to experience something different.”
Goode’s organization has traditionally worked to decriminalize youth behavior and reduce school expulsions. But during the pandemic, Choose 180 pivoted to focus more on mental health, partnering with eight schools in the Highline School District and working with students who aren’t engaging with online learning. Goode said that the “most difficult resource” to connect students with are mental health professionals.
Because of this, the organization decided to hire a behavioral health specialist. Grassroots partnerships are part of a broader array of creative strategies to get students help during the pandemic.
Some ideas suddenly became more scalable during school closures — for example, training programs for teachers and mental health staff went online, increasing participation dramatically.
UW researchers are also working with Hamoda, the Boston Children’s psychiatrist, on a study to scale up mental health services by using digital tools to help teachers better identify students’ needs. That’s particularly important since it can take years for children to get a diagnosis and treatment.
Getting teachers and paraeducators involved “reduces the time for us to wait for a mental health professional to go in,” said Jill Locke, co-director of UW’s SMART Center.
When Grace and Porter return to school, they’ll have tons of changes to get used to. For one, they’ll have to get to know their teachers — nearly all of whom they’ve never met in person.
Porter hopes his relationships with teachers who have reached out to help will strengthen. But he’s bracing himself against more disappointment, knowing school will be far from normal.
Grace is luckier. At least a few teachers have noticed when she feels down. One day, when Grace was taking a Spanish test, she got sidetracked on a question that asked what was different now than before the pandemic.
“I wrote something about it being sad and not feeling as comfortable or free,” she said. A few days later, her teacher asked her to stay after virtual class. “She checked in and she wanted to make sure I was OK,” Grace said. “It was nice to know she was really reading my stuff.”